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Lorraine A. Morandi, MA Director of Human Resources, Plexus Management Group, Westwood, MA

Inside information for anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs) on the most current best practices during changing times.

HR Essentials for Anesthesia Groups: Keys to Finding and Keeping the Best

In the current competitive environment, long-term relationships between anesthesia groups and healthcare organizations are no longer the given they once were, and success for anesthesia practices hinges on their resilience and adaptability as market conditions and hospital requirements change. A cohesive, united group is more likely to weather the uncertainty and preserve the contracts worth keeping.

The human resources (HR) function plays a bigger role in fostering this cohesion and strength than many anesthesia practices realize. A solid HR program encompassing everything from benefits packages to policy and procedure handbooks to recruitment strategies sets a practice's cultural tone, which, in turn, helps groups find and keep clinicians and nonclinicians who fit well within the team.

What's important in HR now? These are some of the top HR issues facing anesthesia groups in 2019 and beyond. We encourage groups to begin incorporating serious consideration for these issues into their HR programs if they haven't started doing so already.

Recruitment and retention: The notion of supply and demand will be deeply challenged in the coming years, and while the aging of the United States population, the increase in chronic disease burden, the number of physicians nearing retirement age and other demographic and health trends will continue to produce more healthcare jobs than ever, including more jobs for anesthesia practitioners, this also means that worker shortages will continue to exist at all levels.

Anesthesia groups will be required to compete for a shrinking pool of qualified providers to meet growing demand. As a result, workforce planning and the creative design of recruitment and retention tools to attract top-notch anesthesiologists and ensure adequate clinical coverage for the group's mix of hospitals, ambulatory surgery centers (ASCs) and other facilities will become increasingly important.

Recruitment and retention strategies should incorporate such elements as carefully designed benefits packages that reflect, as realistically as possible, the wants and needs of a broad swathe of candidates; consideration for work/life balance and vacation time; realistic workloads; opportunities to build community and collegiality among group members; and opportunities for leadership development on committees and through other venues. Anesthesia practices also should take the time to define the non-negotiable qualities and qualifications their group is seeking in clinicians who will be invited to join the group.

Employee engagement: As a corollary to recruitment and retention, the need to foster an environment in which people thrive and want to come to work every day and be the best they can is growing as the workforce shrinks, competition tightens and physician burnout grows. Anesthesia groups must invest time and energy in holding on to their people. You hire them for a reason, so why not find ways to keep them rather than expend the upwards of 30 percent of an annual salary required to replace them?

Sexual harassment: Anesthesia practices must adopt and enforce a zero tolerance policy regarding any and all kinds of harassment, or face dire and expensive consequences. The #MeToo movement has pushed the issue of sexual harassment, in general, and workplace sexual harassment, in particular, into the spotlight, and that is a healthy thing, since most sexual harassment incidents go unreported and uninvestigated, and an environment in which sexual harassment occurs can have serious direct and indirect repercussions.

Less than one-fourth (23 percent) of reported incidents of sexual harassment resulted in an investigation, Medscape's Sexual Harassment of Physicians: Report 2018 revealed. Further, only 40 percent of physicians who were harassed reported the behavior. "Most places don't know how to conduct an investigation, and many HR departments don't recognize the nuances of sexual harassment issues," said consultant Susan Strauss, RN, EdD, in the report.

Seven percent of physicians said they experienced some form of sexual harassment within the past three years. Not surprisingly, medical residents were more likely (78 percent) than working physicians (55 percent) to not confront the perpetrator when harassment occurred. Medscape's report of sexual harassment among other clinicians, including nurses, nurse practitioners and physician assistants, found that 10 percent of respondents were sexually harassed within the past three years.

To address this issue as part of an overall effort to create a supportive work environment, we recommend that anesthesia groups consider sponsoring training led by an employment attorney or other specialist. However, regardless of whether training is an option, anesthesia groups should, at a minimum, develop policies for their employee handbooks covering a definition of harassment, reporting mechanisms and the consequences in order to eliminate ambiguity about expectations for employee behavior.

Drug testing and substance abuse: Deaths from accidental drug overdoses are on the rise, and more states are legalizing marijuana. Practices must be particularly sensitive to ensuring a drugfree environment in which the use and abuse of legal and illegal drugs is not tolerated.

As professionals who hold responsibility for patients' lives perioperatively, it is critical for anesthesiologists struggling with substance abuse problems to receive prompt treatment. Well-defined policies and procedures related to workplace drug testing and substance abuse can help anesthesia practices clarify the ambiguity and uncertainty that often surrounds this issue.

Although the overall incidence of drug abuse is not consistently higher among anesthesia practitioners than other specialties, anesthesiologists are consistently over-represented in drug treatment centers, according to the International Anesthesia Research Society. Anesthesiologists account for 12 to 14 percent of physicians treated in three well-known treatment programs, but they constitute only four percent of U.S. physicians.

As the current opioid epidemic continues to rage and marijuana becomes legalized in a growing number of states, it's more important than ever for anesthesia practices to have steps in place for addressing suspected substance abuse among staff and to be prepared to act as a referral resource.

As with sexual harassment, policies and procedures communicating expectations and consequences for all employees as part of a comprehensive employee handbook can go a long way in addressing a situation of that is often fraught with indecision. Policies and procedures should include off-site treatment resources.

Employee handbooks: Running a smooth practice requires consistent communication and messaging about the group's mission statement, goals, job classifications, policies, procedures and benefits. Well-written, up-to-date handbooks aligned with current legislation are an essential component of effective workforce management. Their value to an anesthesia practice can't be overstated. Signing on to become part of a practice is a major commitment. The employee handbook is the playbook that helps individuals function effectively within the group.

In addition, the handbook must accurately reflect the wide range of federal, state and local laws related to various aspects of the work environment, such as sick leave. HR must revise the handbook as these laws change. Some policies are driven by practice size. The Family Medical Leave Act (FMLA), for example, pertains to organizations with 50 or more employees within a 75-mile radius. For anesthesia practices with fewer practitioners, an FMLA policy would not be required. It's important for groups to know all of the applicable laws.

Employee wellness: A valuable way to keep productivity high and absenteeism low is to include employee wellness programs in benefits offerings. According to Glassdoor, 88 percent of employees who report a high level of overall wellbeing also report feeling engaged at work.

As clinicians with enormous responsibilities and demanding schedules who deal with complex and often critical situations, anesthesiologists and CRNAs experience a great deal of stress. Employee wellness programs can play a crucial role in this regard.

One type of employee benefit that fits under this category is the Employee Assistance Program (EAP), through which employees can receive confidential guidance, support and information via an external source through a toll-free number for the full range of issues that can affect job performance, health, and mental and emotional well-being, including disruptive behavior and marriage and financial problems.

The design of an employee wellness program is highly subjective and can vary widely from group to group in the range and types of benefits offered. One group may allocate resources for a fitness center, while another may decide that focusing more on mental health services should take priority.

Benefits: Although benefits are only part of the picture when it comes to attracting qualified clinicians, the more comprehensive the package, the better. In addition to medical, dental, life and disability benefits, candidates will want to know the perks they will receive on top of these essentials, such as sign-on bonuses, relocation stipends, tuition reimbursement and continuing medical education stipends. Again, there is no one-size-fits-all solution to benefits package design, but the benefits package can tip a candidate's decision in favor of your group. A robust benefits offering can make or break the attractiveness of an employment offer and strengthen your ability to recruit and retain superior talent.

In a highly competitive marketplace, simply making basic benefits available is hardly enough, as there is always a need to assess and compare what other practices are offering. Having knowledge of benefit coverage levels across the industry can help your practice design a benefits program that stands out.

Employee leave: Issues around leave have become incredibly complex. Never before have practices had to track, document and manage as many layers and types of employee leave as in the current environment, including sick leave, family leave, medical leave, military leave, jury duty, domestic violence leave and many others.

Group managers and supervisors need training and education to ensure the group applies leave laws in a fair and nondiscriminatory manner. Decisions regarding the various types of leave a group offers will depend to some extent on its demographic makeup. For example, a relatively younger clinician population might be more likely to expect leave benefits pertaining to childbirth.

Technology: Today's highly technology-connected employees want and expect the convenience of quick access to benefits and other HR-related information. Practices should consider investing in the development of technology-based solutions that fulfill these needs, such as a website or portal that allows employees to manage their benefits online or browse the handbook for policy information, or a mobile phone app for reporting time and attendance.

At the same time, practices must take steps to protect their information, equipment and proprietary intelligence, and must be especially careful to employ HIPAA-compliant policies and strategies to protect their employees' private health information.

Compliance: An effective HR function must stay abreast of when and how to incorporate federal, state and local employment mandates into employee policies and procedures in order to comply with the law. Key factors in this ongoing process include the size of the workforce and the state in which the group operates. HR can help train managers and supervisors on emerging trends in federal, state and local laws and help keep documentation current.

For example, the FMLA, which provides up to 12 weeks of unpaid, job-protected leave to eligible employees, doesn't apply to organizations with fewer than 50 workers. If your group is smaller, what benefit will it provide when an employee requests maternity leave?

Finding and keeping top clinical and professional talent is a key to building competitive advantage in an unpredictable market. Though a solid HR program is central to that, some anesthesia groups tend to push HR concerns to the side as issues of contract negotiation, business development and financial planning take precedence. Anesthesia group leaders must be HR savvy and recognize that HR isn't a separate silo; it permeates and influences every aspect of practice management.